Provider Demographics
NPI:1487724548
Name:LAWLESS, LINDA L (LMFT, LMHC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5048
Mailing Address - Country:US
Mailing Address - Phone:707-554-4390
Mailing Address - Fax:707-780-8938
Practice Address - Street 1:121 OHIO ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5048
Practice Address - Country:US
Practice Address - Phone:707-554-4390
Practice Address - Fax:707-780-8938
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC207101YM0800X
CAMFC21588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist